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Evaluation of the effect of intratympanic injection of gentamicin for resistant cases of Meniere’s disease on hearing and vestibular functions

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Abstract

Objectives

This study was performed to investigate the effect of a single minimal dose of intratympanic injection (IT) gentamicin on hearing and otolithic function, mainly on the utricle and saccule independently.

Patients and methods

Our study was performed on 10 patients with definite Meniere’s disease diagnosed according to AAO-HNS criteria and who had been showing resistance to medical treatment for more than 6 months with persistent vertigo affecting their lifestyle.

IT of gentamicin was given under local anesthesia through direct perfusion in a single dose of 12 mg (0.3 ml of 40 mg/ml) unilaterally on the lesion side.

Preinjection evaluation included history, otoscopy, formal pure tone audiometry (PTA), and tympanometry. In addition, cervical vestibular-evoked myogenic potential (cVEMP) and oVEMP were tested. One month after injection, PTA and both VEMP tests were again carried out. Data before and after injection were analyzed and correlated.

Results

No overall significant effect on hearing was found. IT gentamicin had significant effect on cVEMPs with 100% abolition, as well as a statistically significant effect on oVEMP with 70% abolition and distortion of the remaining 30%. In these remaining 30% latencies and amplitudes, there was no significant difference in values before and after injection.

Conclusion

A 12 mg single dose of gentamicin can abolish otolithic function without affecting hearing.

References

  1. 1

    Kasemsuwan L, Jariengprasert C, Chaturapatranont S. Transtympanic gentamicin treatment in Meniere’s disease: a preliminary report. J Med Assoc Thai 2006; 89: 979–985.

    PubMed  Google Scholar 

  2. 2

    Klockhoff I, Lindblom U, Stahle J. Diuretic treatment of Meniere disease. Long-term results with chlorthalidone. Arch Otolaryngol 1974; 100: 262–265.

    CAS  Article  Google Scholar 

  3. 3

    Brown JS. A ten year statistical follow-up of 245 consecutive cases of endolymphatic shunt and decompression with 328 consecutive cases of labyrinthectomy. Laryngoscope 1983; 93: 1419–1424.

    CAS  Article  Google Scholar 

  4. 4

    Schuknecht HF. Ablation therapy in the management of Meniere’s disease. Acta Otolaryngol Suppl 1957; 132: 1–42.

    CAS  PubMed  Google Scholar 

  5. 5

    Lange G. Gentamicin and other ototoxic antibiotics for the transtympanic treatment of Meniere’s disease. Arch Otorhinolaryngol 1989; 246: 269–270.

    CAS  Article  Google Scholar 

  6. 6

    Kimura RS. Distribution, structure, and function of dark cells in the vestibular labyrinth. Ann Otol Rhinol Laryngol 1969; 78: 542–561.

    CAS  Article  Google Scholar 

  7. 7

    Nedzelski JM, Chiong CM, Fradet G, Schessel DA, Bryce GE, Pfleiderer AG. Intratympanic gentamicin instillation as treatment of unilateral Meniere’s disease: update of an ongoing study. Am J Otol 1993; 14: 278–282.

    CAS  Article  Google Scholar 

  8. 8

    Kaplan DM, Nedzelski JM, Chen JM, Shipp DB. Intratympanic gentamicin for the treatment of unilateral Meniere’s disease. Laryngoscope 2000; 110: 1298–1305.

    CAS  Article  Google Scholar 

  9. 9

    Pullens B, van Benthem PP. Intratympanic gentamicin for Meniere’s disease or syndrome. Cochrane Database Syst Rev 2011; 3: CD008234.

    Google Scholar 

  10. 10

    Kasemsuwan L, Jariengprasert C, Ruencharopen S, Orathai P. Low dose transtympanic gentamicin treatment for intractable Meniere’s disease: a prospective study. J Med Assoc Thai 2007; 90: 327–334.

    PubMed  Google Scholar 

  11. 11

    Schuknecht HF. Pathophysiology of endolymphatic hydrops. Arch Otorhinolaryngol 1976; 212: 253–262.

    CAS  Article  Google Scholar 

  12. 12

    Rauch SD, Merchant SN, Thedinger BA. Meniere’s syndrome and endolymphatic hydrops. Double-blind temporal bone study. Ann Otol Rhinol Laryngol 1989; 98: 873–883.

    CAS  Article  Google Scholar 

  13. 13

    Day AS, Lue JH, Yang TH, Young YH. Effect of intratympanic application of aminoglycosides on click-evoked myogenic potentials in Guinea pigs. Ear Hear 2007; 28: 18–25.

    Article  Google Scholar 

  14. 14

    Helling K, Schonfeld U, Clarke AH. Treatment of Meniere’s disease by low-dosage intratympanic gentamicin application: effect on otolith function. Laryngoscope 2007; 117: 2244–2250.

    CAS  Article  Google Scholar 

  15. 15

    Chiarovano E, Zamith F, Vidal PP, de Waele C. Ocular and cervical VEMPs: a study of 74 patients suffering from peripheral vestibular disorders. Clin Neurophysiol 2011; 122: 1650–1659.

    Article  Google Scholar 

  16. 16

    De Waele C, Meguenni R, Freyss G, Zamith F, Bellalimat N, Vidal PP, et al. Intratympanic gentamicin injections for Meniere disease: vestibular hair cell impairment and regeneration. Neurology 2002; 59: 1442–1444.

    Article  Google Scholar 

  17. 17

    Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113:181–185.

    Article  Google Scholar 

  18. 18

    Sala T. Transtympanic gentamicin in the treatment of Meniere’s disease. Auris Nasus Larynx 1997; 24: 239–246.

    CAS  Article  Google Scholar 

  19. 19

    Welgampola MS, Colebatch JG. Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology 2005; 64: 1682–8.

    Article  Google Scholar 

Download references

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Correspondence to Samir Asal MD.

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None declared.

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Baki, F., Asal, S., Shewel, Y. et al. Evaluation of the effect of intratympanic injection of gentamicin for resistant cases of Meniere’s disease on hearing and vestibular functions. Egypt J Otolaryngol 31, 135–139 (2015). https://doi.org/10.4103/1012-5574.156099

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Keywords

  • cervical vestibular-evoked myogenic potential
  • gentamicin
  • intratympanic injection
  • Meniere’s disease
  • ocular vestibular-evoked myogenic potential
  • otolith